Dermatology III Highlights

Question 1

1) What is the most common cancer?
2) Etiology of this cancer?
3) Most common locations?
4) List some risk factors

Answer 1

1) BCC (basal cell)
2) UVB
3) 70% on face/chest; “Danger sites”
4) Fair skin (I-III), light-colored eyes, red hair, prolonged sun exposure

Question 2

1) What is a clinical sub-type of BCC?
2) What are 2 histologic subtypes?
3) Is BCC fast or slow growing?

Answer 2

1) Morpheaform
2) Micronodular & infiltrative
3) Slow-growing

Question 3

1) What is the most common cancer?
2) What is the etiology?
3) Where on the body are most located?

Answer 3

1) BCC
2) Ultraviolet light (UVB)
3) 70% on face/chest; “Danger sites”

Question 4

1) What are some risk factors of BCC?
2) Is it fast or slow growing?

Answer 4

1) Fair skin (I-III), light-colored eyes, red hair, prolonged sun exposure
2) Slow growing

Question 5

List 1 clinical & 2 histologic sub-types of BCC

Answer 5

1) Clinical: morpheaform
2) Histologic:micronodular, infiltrative

Question 6

Basal cell carcinoma (BCC):
1) What is needed to Dx?
2) What are important aspects of Tx?

Answer 6

1) Biopsy
2) Excision; cryosurgery and electrosurgery limited, Mohs best for morpheaform + sensitive sites/ scalp

Question 7

What is the most common subtype of BCC? What does it look like?

Answer 7

Nodular BCC; pearly w. rolled border

Question 8

Ill-defined borders & scar-like appearance is characteristic of what type of BCC?

Answer 8

Morpheaform BCC

Question 9

Squamous cell carcinoma:
1) Name 2 risk factors
2) What may it arise from?
3) How is it diagnosed?

Answer 9

1) Sun exposure + organ transplant
2) Actinic keratosis
3) Biopsy

Question 10

What is an invasive SCC Tx?

Answer 10

Excision or Mohs surgery

Question 11

Scaly, light red to pink spot with telangiectasias is characteristic of what carcinoma’?

Answer 11

SCC

Question 12

1) What offers superior histologic analysis of tumor margins while permitting maximal conservation of tissue compared with standard surgical excision?
2) Are recurrence rates higher or lower with this method?

Answer 12

1) Mohs Micrographic surgery (MMS)
2) Tend to be lower

Question 13

What is the leading cause of death due to skin disease and least common type of skin cancer?

Answer 13

Melanoma

Question 14

What is the single most important prognostic factor for melanomas?

Answer 14

Tumor thickness at time of Dx

Question 15

What is the most important factor of ABCDE criteria for melanoma

Answer 15

Changing mole (evolution)

Question 16

What lesions does the ABCDE criteria for melanomas apply to?

Answer 16

Pigmented lesions

Question 17

1) List some important melanoma diagnosis methods
2) What are some melanoma Txs?

Answer 17

1) Excisional biopsy-must take wide margin (1 cm margin for every 1mm of lesion depth.)vs punch biopsy
2) Excision, referral, or sentinel lymph node biopsy (all lesions >1mm)

Question 18

Who are the 4 clinical variants of kaposi sarcoma often seen in?

Answer 18

Those with immunodeficiencies/ HIV/AIDS

Question 19

1) What is one characteristic of atypical nevi?
2) When do they have increased risk of melanoma?

Answer 19

1) Diameter > 5mm
2) Pts with >50 nevi with >1 atypical nevi & 1 nevus >8 mm

Question 20

Atypical nevi:
1) Where are they most common?
2) What is one way they may appear?

Answer 20

1) Most common on trunk & extremities
2) “Fried egg”

Question 21

1) What is a basic rule of suspicious lesions?
2) Why does this rule exist?

Answer 21

1) Never do a superficial shave biopsy of a pigmented lesion that is a possible melanoma.
2) The most important determinant of survival in melanoma is the Breslow depth, or tumor thickness, of the initial tumor.

Question 22

1) What is the most common cause of abscesses?
2) What are 2 main characteristics of abscesses?

Answer 22

1) S. aureus
2) Fluctuance, very painful

Question 23

1) What must you do for all abscesses?
2) What should you not do?

Answer 23

1) Must perform incision and drainage (I&D) irrigation
2) Do not typically need PO antibiotics
-typically will heal up after drainage w/o further antibiotics or treatment

Question 24

What is an infection of the dermis & subcutaneous tissue called?

Answer 24

Cellulitis

Question 25

1) Is cellulitis usually bilateral or unilateral?
2) What is the typical etiology?
3) What is an important part of Tx?

Answer 25

1) Unilateral
2) Streptococci or S. a
3) Mark borders to monitor progress

Question 26

Name a contagious bacterial infection that progresses to a honey-colored crust

Answer 26

Impetigo

Question 27

When should you admit a pt with cellulitis?

Answer 27

1) Severe local symptoms
2) WBC > 10K
3) Failure to respond to PO antibiotics
4) Systemic symptoms

Question 28

Superficial form of cellulitis due to strep is called what?

Answer 28

Erysipelas

Question 29

What is typically found on the face with borders better defined than cellulitis?

Answer 29

Erysipelas

Question 30

Mupirocin can treat what?

Answer 30

Impetigo

Question 31

1) Who is the Rule of Nines for?
2) When should you transfer to burn unit?
3) What % is the palm?

Answer 31

1) Adult burn pts
2) At 5-10% BSA
3) Palm 1%

Question 32

1) When is a burn considered severe?
2) What are the ABCs of burns?
3) What is the formula for fluid? (don’t need to memorize). What else do you need to give the pt?
4) What is a predictor of worse burn outcomes?

Answer 32

1) >20% TBSA
2) Airway, Breathing, Circulation, Disability, Exposure
3) Parkland formula: adults: 4ml/kg x % TBSA, ½ given first 8 hrs = MLs of fluid needed in first 24 hrs
-Tetanus/pain meds
4) Hyperglycemia

Question 33

Overlying black comedone (punctum) could be what?

Answer 33

Epidermal inclusion cyst (EIC)

Question 34

What should you tell epidermal inclusion cyst (EIC) pts who you decide not to Tx?

Answer 34

Tell patients not to manipulate

Question 35

What stage of a pressure ulcer is skin fully intact?

Answer 35

Stage 1 (not even epidermis is involved, just redness)

Question 36

What hormone-related skin pigmentation change usually results from exposure to sunlight?

Answer 36

Melasma

Question 37

What can cause a painless chancre, then have a rash on the palms and soles?

Answer 37

Syphilis (treponema pallidum)

Question 38

What topical steroid penetrates the skin the most?

Answer 38

Ointment (only use for important things)

Question 39

List the classes of steroid potencies and give an example of each
(C = cream, F = foam, G = gel, L = lotion, O = ointment)

Answer 39

Class 1: Very high potency
-Clobetasol 0.05% C F G L O
Class 2: High potency
-Fluocinonide 0.05% C G O S
Class 3: High potency
-Triamcinolone 0.1% O (good)
Class 4: Mid potency
-Triamcinolone 0.1% C
Class 5: Mid potency
-Hydrocortisone butyrate 0.1% cream
Class 6: Low potency
-Desoride 0.05% C L O (really only for babies)
Class 7: Low potency
-**Hydrocortisone hydrochloride: .25% CL; .5%, 1%, 2%, 2.5% CLOS,

Question 40

Continuous daily Tx w. steroids for longer than ________ weeks is not recommended

Answer 40

4

Question 41

List 3 steroids and how to dose them

Answer 41

1) Clobetasol propionate 0.05% foam >12 yrs
2) Desonide 0.05% foam/ gel >3 months
3) Hydrocortisone butyrate 0.1% cream >3 months

Question 42

List some adverse effects of topical steroids (that can happen w continuous daily use)

Answer 42

1) Bruising
2) Skin thinning
3) Tinea incognito
4) Prominent capillaries
5) Stretch marks
6) Localized pustular psoriasis